공고요법까지 관해상태를 유지한 소아 급성골수성백혈병에서 자가조혈모세포이식의 치료 효과 비교

Abstract

Purpose: In many studies, allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is the most effective treatment of acute myeloid leukemia (AML). Autologous hematopoietic stem cell transplantation (Auto-HSCT) is another choice of treatment in patients who do not have an HLA matched donor. But overall results comparing Auto-HSCT to Allo-HSCT and chemotherapy only have been inconsistent. We report the results of Auto-HSCT in childhood AML patients. Methods: From the retrospectively maintained database at the Pediatric Department of Severance Hospital, we identified patients less than 15 years of age. They achieved remission and continuous complete remission during consolidation chemotherapy. They were treated with Auto-HSCT, Allo-HSCT or chemotherapy only. Event-free-survival (EFS) rates were estimated by the method of Kaplan and Meier, and confidence intervals were calculated using log-rank test. Results: 16 children with AML who achieved remission and continuous complete remission during consolidation chemotherapy were selected. They were eligible for allocation to Allo-HSCT (n=7) or to Auto-HSCT (n=5) or chemotherapy only (n=4). EFS of 3 years is as follows: Allo-HSCT, 71.4%±17.1%; Auto-HSCT, 100%; and chemotherapy only, 25%±22%. EFS in Auto-HSCT is significantly superior to chemotherapy only (P=0.04). Differences between Auto-HSCT and Allo-HSCT are not significant (P=0.21). Conclusion: When patients with AML who achieved remission and continuous complete remission during consolidation chemotherapy had no HLA matched donor, Auto-HSCT was a more effective therapy than chemotherapy only and had similar effectiveness with Allo-HSCT.